00 Hypertension Flashcards by Chris Clark

What blood pressure is considered “Pre-Hypertension”?

S: 120-139 or D: 80-89

How well did you know this?

Not at all

Perfectly

What blood pressure is considered “Stage 1 Hypertension”?

S: 140-159 or 90-99

How well did you know this?

Not at all

Perfectly

For the general population > 60 years, when should BP treatment be initiated?

SBP: 150+ or DBP: 90+

How well did you know this?

Not at all

Perfectly

For the general population < 60 years, when should BP treatment be initiated?

SBP: 140+ or DBP: 90+

How well did you know this?

Not at all

Perfectly

For 18+ years with CKD, when should BP treatment be initiated?

SBP: 140+ or DBP: 90+

How well did you know this?

Not at all

Perfectly

For 18+ years with diabetes, when should BP treatment be initiated?

SBP: 140+ or DBP: 90+

How well did you know this?

Not at all

Perfectly

What is recommended for initial treatment in the general population +/- DM (non-black)?

Thiazide diuretic, CCB, ACE-I, ARB

How well did you know this?

Not at all

Perfectly

What is recommended for initial treatment in 18+ years, CKD, any race, +/- DM?

ACE-I or ARB (both of these could be initial or add-on to improve kidney outcomes)

How well did you know this?

Not at all

Perfectly

What is recommended for initial treatment in the general black population?

Thiazide diuretic, CCB

How well did you know this?

Not at all

Perfectly

If a loop and thiazide are given together, how must you space them?

Thiazide first, followed by loop one hour later

How well did you know this?

Not at all

Perfectly

How do thiazides work?

Inhibits sodium reabsorption in the DISTAL CONVOLUTED TUBULES –> increase water excretion

How well did you know this?

Not at all

Perfectly

What is the generic name for Diuril?

Chlorothiazide (Thiazide)

How well did you know this?

Not at all

Perfectly

What is the generic name for Lozol?

Indapamide (Thiaizde)

How well did you know this?

Not at all

Perfectly

What is the generic name for Zaroxolyn?

Metolazone (Thiaizde)

How well did you know this?

Not at all

Perfectly

What is the generic name for Thalitone?

Chlorthalidone (Thiazide)

How well did you know this?

Not at all

Perfectly

What is the only thiazide that can be given IV?

Diuril (Chlorothiazide)

How well did you know this?

Not at all

Perfectly

What are the only thiazides that are effective when CrCl < 30?

Lozol (Indapamide) and Zaroxolyn (Metolazone)

How well did you know this?

Not at all

Perfectly

What are the electrolyte imbalances caused by thiazides?

Hypo: K, Na, Mg, Cl. Hyper: Ca

How well did you know this?

Not at all

Perfectly

What are the metabolic ADRs caused by thiazides?

Hyperglycemia, hyperuricemia, hypercholesterolemia. Photosensitivity

How well did you know this?

Not at all

Perfectly

What are the contraindicates to thiazide use?

Sulfa allergy, Anuria, Renal decomposition, Pregnancy

How well did you know this?

Not at all

Perfectly

What is the MOA of loop diuretics?

Inhibits Na and Cl reabsorption in the ASCENDING LOOP OF HENLE and the distal renal tubule –> increased water excretion

How well did you know this?

Not at all

Perfectly

What is the generic name of Lasix?

Furosemide (loop)

How well did you know this?

Not at all

Perfectly

What is the generic name of Demadex?

Torsemide (loop)

How well did you know this?

Not at all

Perfectly

What is the generic name of Bumex?

Bumetanide (loop)

How well did you know this?

Not at all

Perfectly

What is the generic name of Edecrin?

Ethacrynic Acid (loop) - only loop and thiazide that has no precaution with sulfa allergy

What are the Oral Loop Equivalents?

40 furosemide ~ 1 bumetanide ~ 10-20 torsemide

Whats unique about the IV formulations of loop diuretics?

They are light sensitive

What are the electrolyte imbalances caused by Loops?

Hypo: Na, K, Mg, Cl, AND Ca

When are Loops contraindicated?

Anuria

What is the BBW with Loops?

Excessive amounts --> profound diuresis --? fluid/electrolyte depletion

What is the MOA of Potassium Sparing/Aldosterone Antagonist Diuretics?

Competitive aldosterone antagonist in the distal renal tubule, leads to increase in Na, Cl, and water excretion while conserving K and H ions

What is the generic name of Midamor?

Amiloride (K-Sparing)

What is the generic name of Dyrenium?

Triamterene (K-Sparing)

What is the generic name of Inspra?

Eplerenone (Aldosterone Antagonist)

What is the generic name of Aldactone?

Spironolactone (Aldosterone Antagonist)

What is the only route that K-sparing and aldosterone antagonists can be give?

How do Eplerenone and Spironolactone compare?

Eplerenone is ~100 times more potent than spironolactone

What electrolyte imbalance can be caused by k-sparing/aldosterone antagonists?

Hypo: Na, Mg

What is a unique ADR of Triamterene?

Nephrolithiasis

What is a unique ADR of Spironolactone?

Gynecomastia

What is the BBW with Spironolactone?

Tumorigenic

What is the BBW for both K-sparing diuretics?

Potentially fatal hyperkalemia

What is the generic name of Lotensin?

Benazepril (ACE-I)

What is the generic name of Capoten?

Captopril (ACE-I)

What is the generic name of Vasotec?

Enalapril (PO), Enalaprilat (IV) (ACE-I)

What is the generic name of Prinivil, Zestril?

Lisinopril (ACE-I)

What is the generic name of Altace?

Ramipril (ACE-I)

What is the only ACE-I that comes in IV form?

Enalaprilat

What are some common ADRs with ACE-I?

CAPTOPRIL: Cough, Angioedema, Pancreatitis/Proteinuria, Taste loss, Orthostatic hypotension, Pregnancy category D, Renal failure/rash, Increased potassium, Lithium increases

What is the generic name of Atacand?

Candesartan (ARB)

What is the generic name of Cozaar?

Losartan (ARB)

What is the generic name of Benicar?

Olmesartan (ARB)

What is the generic name of Diovan?

Valsartan (ARB)

What is the generic name of Tekturna?

Aliskiren (Direct Renin Inhibitor)

What is the generic name of Norvasc?

Amlodipine (CCB)

What is the generic name of Plendil?

Felodipine (CCB)

What is the generic name of Cardene?

Nifedipine (CCB)

What is the generic name of Sular?

Nisoldipine (CCB)

What is the only DHP-CCB that can be given IV?

Cardene (Nicardipine)

What are some common ADRs with DHP-CCBs?

Peripheral edema, Reflex tachycardia (mostly with Nicardipine and Nisoldipine), Flushing, HA/dizziness, Gingival hyperplasia, Rash

What are DDI's like with DHP-CCBs?

All of them are substrates of 3A4

What is the generic name of Cardizem?

Diltiazem (Non-DHP CCB)

What are some other brand names of Diltiazem?

Dilacor, Diltia, Tiazac, Taztia

What is the generic name of Calan?

Verapamil (Non-DHP CCB)

What is the most common ADR with Diltiazem?

HA and flushing

What is the most common ADR with Verapamil?

Constipation and Gingival hyperplasia

What are the DDI's like with Non-DHP CCBs?

Both 3A4 substrates and inhibitors

What is the generic name of Tenormin?

Atenolol (b1-selective BB)

What is the generic name of Lopressor?

Metoprolol Tartrate (b1-selective BB)

What is the generic name of Brevibloc?

Esmolol (b1-selective BB)

What is the generic name of Toprol XL?

Metoprolol Succinate (b1-selective BB)

What is the generic name of Bystolic?

Nebivolol (b1-selective BB AND increases NO production--> vasodilation)

What are the B1-Selective BBs?

"No AMEBBA": Nebivolol, Atenolol, Metoprolol, Esmolol, Betaxolol, Bisoprolol, Acebutolol

Which type of BB's cause more bradycardia?

B1-selective

Which type of BB's are a more suitable consideration for patients with asthma?

B1-selective

What is the generic name of Sectral?

Acebutolol (partial b-receptor agonist w/ ISA activity)

What is the generic name of Visken?

Pindolol (partial b-receptor agonist w/ ISA activity)

What are the Partial B-receptor agonist BB's with Intrinsic Sympathomimetic Activity (ISA)?

"CAPP": Carteolol, Acebutolol, Penbutolol, Pindolol

Which BB's have high lipid solubility?

Propranolol, Penbutolol, Carvedilol

What are the ADRs with BB's that have high lipid solubility?

Cross BBB easier, more CNS side effects: sedation, mental confusion, nightmares. Increased first past metabolism, shorter duration of action

What are the contraindications to BB use?

2nd/3rd degree heart block. Sinus bradycardia (HR < 50-55). Severe/uncontrolled asthma. Decompensated cardiac failure. Pregnancy. Caution in diabetics d/t masking hypoglycemia symptoms

What is the generic name of Coreg?

Carvedilol (combined non-selective a/b blocker)

What is the generic name of Normodyne, Trandate?

Labetalol

How should patients take Carvedilol?

With food

What is the generic name of Minipress?

Prazosin (a-1 blocker)

What is the generic name of Hytrin?

Terazosin (a-1 blocker)

What is the generic name of Cardura?

Doxazosin (a-1 blocker)

What are some common ADRs with a-1 blockers?

Orthostatic hypotension (including "1st" dose phenomenon). Sodium and fluid retention

What are a-1 blockers contraindicated?

With concurrent use of PDE-5 inhibitors

What is the generic name of Catapress?

Clonidine (central/peripheral acting a-2 adrenergic agonist)

What is the generic name of Kapvay?

Clonidine ER (central/peripheral acting a-2 adrenergic agonist)

What is the generic name of Aldomet?

Methyldopa (central/peripheral acting a-2 adrenergic agonist)

What is the generic name of Serpasil?

Reserpine (central/peripheral acting a-2 adrenergic agonist)

What are some common ADRs with clonidine?

Sedation (tolerance does not develop), orthostatic hypotension, dry mouth, constipation

When is methyldopa contraindicated?

Active liver disease. Concurrent use of MAO-I

When is reserpine contraindicated?

Active GI disease (eg ulcers, etc), depression, severe renal failure, ulcerative colitis

What is the generic name of Apresoline?

Hydralazine (direct vasodilator)

What is the generic name of Loniten?

Minoxidil (direct vasodilator)

What is a unique ADR of Minoxidil?

Hirsutism

What medications are used for Hypertensive Urgency?

PO Medications: Captopril, Clonidine, Labetalol. Reduce BP gradually over 24-48 hours to safe levels (<160/100)

What medications are used for Hypertensive Urgency?

Use IV meds: Sodium nitroprusside, Nitroglycerine, Labetolol, Esmolol, Propranolol, Nicardipine, Clevidipine, Fenoldopam mesylate, Hydralazine, Phentolamine, Enalaprilat

What is the general recommendation for HTN in pregnancy?

Start with methyldopa or labetalol (methyldopa is still DOC). If additional treatment is needed: long acting CCB Nifedipine is safe. NO ACE-I, ARBs, DIRECT RENIN INHIBITOR!!!

What is the DOC for preeclampsia?

Hydralazine